25: If You’re Sick, Stay Home

Scot: "Who Cares About Men's Health" take one.

Troy: How many takes do we have? We usually only do one take. I was going to say . . .

Scot: We only have one take, so get it right, gentlemen. It's a podcast that is out to prove a point and also start a movement that men do care about their health, and it's cool to care about your health. My name is Scot. I am the Senior Producer of thescoperadio.com, and I care about men's health.

Troy: Are we doing first names only today?

Scot: Wow, you really pay attention.

Troy: I'm Troy.

Scot: Okay. Fine. First names it is.

Troy: I'm Dr. Troy Madsen. I'm an emergency physician at University of Utah, and I care about men's health.

Justin: I'm Justin Knox. I'm a PA working for the University of Utah in urgent care, and I care about men's health.

Scot: Justin, him and his wife are expecting their first child.

Justin: Yep.

Scot: Yeah, so . . .

Justin: Here at the end of the month.

Scot: Yeah, that's pretty exciting.

Troy: Wow.

Scot: So before we usually kick into the show, I always like to ask our guests a question about their health. How do you think this first child is going to affect your routines and your rituals, your nutrition, your diet, your . . . those are the same thing. Your exercise, your sleep, your mental health. Have you thought about that at all, or no?

Justin: I have actually. I'm almost 40, and I've been able to be pretty selfish most of my life. But I suppose when you have a baby, you can't be selfish anymore. So I would imagine sleep will go down and, you know, taking runs in the morning and that kind of thing.

Scot: Have you thought about how you're going to actually be able to keep activity up and make it a part of your life so it doesn't completely disappear? We've talked to many men. That can be the turning point for the worse, and then they realize, "Oh, boy, I've neglected myself," and they have to turn that back around. Or is that just going to happen?

Justin: I mean, I think at least in my relationship, it's about communicating and saying, "Hey, I need some time for myself. You okay with the baby?" We've talked about this stuff, so I think there's going to be room. It's just a matter if I'm motivated after, you know, a late night kind of thing.

Scot: I'm in a graduate program right now, which is not nearly as exciting as welcoming a new child into the world, and I've been struggling. And I guess I've just had to re-imagine what that means. In between my study breaks, I'll do some push ups or back exercises. Maybe I'll try to get out just for a 10-minute walk or something like that. So I've found for me breaking it up, not thinking, "I have to go to the gym and then run for an hour," has been really productive. So maybe that will help.

Justin: Yeah, even simple things I think are meaningful.

Scot: All right. Winter problems, things like colds, flus. Let's hit colds first. First of all, just as a layman, how are colds transmitted? Is it through the droplets that are coming out when people sneeze? Is that how you get the virus?

Troy: Yeah. I mean, it's droplets. It's things you may be in touch with or contact with. Maybe someone sneezed and they touched their hand on something and you touch it and pick it up. It's all over. And people often ask me, "How did I catch this and what can I do to avoid it?" And I tell them, "Sometimes there's just absolutely nothing you can do." I will wash my hands all the time in the ER, and I'll wear a mask around someone who's coughing and I still get sick. And it just is going to happen, unfortunately.

Scot: And when somebody comes into the urgent care with a cold, what can you do for them?

Justin: I mean, there's not a whole lot to do other than reassurance. Sometimes, we can offer supportive care, depending on how severe their symptoms are. And that's often what I tell people, is, "We can't necessarily fix what's going on, but we can try to help you feel better."

Troy: And what's your go-to? Let's say you do have that guy come in who says, "Hey, I've got this huge meeting tomorrow. I can't be sick for this, and I can't skip it." And he feels awful. He's got a cold. Do you have a go-to sort of cocktail you tell them, "Hey, try this medication, this medication, do this, and this will help you get through it"?

Justin: Yeah. I think, in general, a lot of viral illnesses . . . you know, the "cold" involves mucus production, which in turn creates cough, and congestion, and that kind of symptom. And so doing good decongestants, at least from my experience, tend to be more helpful than most other things.

Scot: That's good to hear because that's generally how I try to manage my cold. I just try to manage the symptoms as best as possible. So recommendations on . . . like, I go in to the store and you go into that aisle, and I just get overwhelmed with . . . I mean, you've got decongestants. You've got antihistamines.

Troy: Yeah, so many.

Scot: You've got cough suppressants. You've got expectorants. Over time, I've kind of learned what those things do and are. How would somebody that's maybe overwhelmed approach, "What do I need to get?"

Justin: I tend to stick with the old tried and true, you know, Mucinex, or pseudoephedrine I think can be really helpful. Kind of drying up some of this mucus that tends to cause the sore throats, the cough, the difficulty sleeping at night because you're so stuffy.

Troy: I agree. I go to that cold aisle, and I've looked through there just to try and figure this stuff out. And it gives me a headache trying to figure out, "Okay, what's in here? Oh, it's these three medications. Is this for a combination?"

Like you said, it all kind of comes down to the same thing. It's just decongestants. Dry up the mucus. You can take something to help with the cough, and then take something for the pain, ibuprofen or Tylenol.

Scot: And then is it antihistamine that stops the sneezing? Or in a cold do I not need antihistamine?

Troy: I mean, a lot of these decongestants . . . Justin mentioned Sudafed, so pseudoephedrine, that's going to help stop the sneezing because you're drying the mucus up. You could try an antihistamine, maybe Zyrtec, Cetirizine being the generic name, and that would probably help a little bit as well. But my go-to is pseudoephedrine or Sudafed, Guaifenesin, which is going to be helping with the cough, and then Tylenol or ibuprofen and . . .

Scot: For the aches, and pains, and fever.

Troy: For the aches, and pains, and fever, yeah. Just a matter of powering through. You know, sometimes you feel miserable for a week, but it's like you said. All you can do is try and deal with the symptoms and let the body fight the cold off.

Scot: That was the advice you gave me, and as a result, I don't buy the all-in-one anymore. I buy the separate things and then manage the symptoms. And it takes a little bit of extra work, but I've found that to be very effective. And I just take what they recommend on the box. Is that what you both recommend as well?

Justin: Yeah. And then I offer people advice. As far as home remedies, I think having a humidifier can be super helpful, especially here where we live where it's so dry. So, you know, when we get sick with this kind of stuff, the dry environment tends to make things a bit stickier. And so, if you can add some humidity back into your environment, I think that's helpful.

Troy: And what about a neti pot? Some people might use that to clear out the sinuses if they're just really congested. Have you ever used one or recommended one?

Scot: We have one, and my wife swears by it. And every time I get sick, she tells me to use that thing, and I hate it.

Troy: What don't you like about it?

Scot: I can never get it to work right. You've got to . . .

Troy: It goes down your face, and you're like, "I can't get it in my nose."

Scot: It just doesn't come out the other nostril.

Troy: Yeah. It is weird. It takes some getting used to.

Justin: I know a lot of ear, nose, and throat docs will recommend using some type of nasal rinse. You know, it doesn't necessarily have to be a neti pot. There's just really generic things, like a squeeze bottle, or even just nasal saline spray can kind of help loosen stuff up.

Scot: So if it makes you feel better, try it. Okay.

Troy: I've tried using one over the last year or two, and I kind of like it. It took some getting used to because you've got to pour it in one side and you're leaning over and it comes out the other nostril. But I kind of like it. It's a little bit weird, but . . .

Scot: It helps you.

Troy: I felt like it kind of cleared things out a little bit.

Scot: So that's the advantage to you, is it clears out that stuff in your nose so you're not as congested and snorty.

Troy: And it's not just the nose. It's that sinus pressure. That's what gets me, just that pressure in the sinuses, that headache. That's what makes it tough for me to get through a shift. And just doing that seemed to help a little bit.

Scot: All right. So manage the symptoms. There's really no cure for the common cold. What about contagiousness? Is that something that the average person should worry about? I know that, you know, people tend to go into work sick. When do I know I'm not contagious anymore if I decide maybe I'm going to work from home a couple of days? Is there a tried-and-true way to tell?

Justin: Each viral illness probably has a different range. But in general, I would say when people have . . . at the height of their acute symptoms is probably when they're most contagious.

Troy: And when someone's coming in, you know, kind of get into this treatment piece of it, they're coughing, they're sneezing, they have a fever, how often are they coming to you and asking for an antibiotic?

Justin: Very often. Unfortunately, me being a newer provider, I often feel like I'm trying to undo some bad habits from decades in the past. And it's not necessarily, you know, providers were doing things intentionally wrong. We just didn't know what we know now.

And so, yeah, lots of people say, "Hey, I get a Z-Pak or an antibiotic every time I have this every year from my regular provider. So that's kind of what I'm here for." And so, that's the education piece, saying, "Hey, this doesn't always help."

Scot: It doesn't always, or doesn't at all?

Justin: It depends. Some viral illnesses last a long time and they diminish our immune system, and then other potential infectious processes can develop. And so, at that point, we have to decide, "Okay, you've had this for three weeks. It's getting way worse. You're adding new symptoms. Maybe this is not just a typical cold anymore."

Scot: Gotcha. So the initial cold antibiotics is not going to help. If that cold causes some other sort of thing, then perhaps antibiotics might help those symptoms. Okay.

Let's move on to flu. First of all, how do you tell the difference between a cold and a flu?

Justin: I think, in general, a lot of people with the flu versus the common cold is symptoms typically are quite a bit more severe. Body aches, fevers, headaches. I mean, people just feel really terrible. But each year, it seems like there's a shift in how people present.

Scot: Oh, just depending on the strain?

Justin: Yeah, the strain.

Scot: Really?

Troy: That's what's tough about it.

Scot: So some can be worse than others.

Troy: It really can. There was a really bad strain this last year, and I am almost certain I caught that strain. And I remember the patient in the ER. Young, healthy female, super sick, felt miserable. She had a mask on. I went in there, and she was coughing all over. And I'm just like, "I'm going to get it. I'm going to get it." Two days later, I was as sick as I've been in a very long time. And there was this really, really nasty strain that was hitting young, healthy people last year.

So like Justin said, I think sometimes you can't tell the difference because sometimes it's a milder strain, and you have the fever, you have cough, you hurt, but then there are other times where you just feel like death and you just feel so horrible. So it's tough.

Scot: And unlike the cold, there is a shot for the flu that you can get if you get it within 48 hours I've understood, like Tamiflu. Isn't that what it's called? Is that effective or no? I'm getting questioning looks here.

Troy: Well, it's not a shot. That's the one thing.

Scot: Oh, I think it's a nasal . . . is it a nasal thing?

Justin: You might be thinking of the vaccine. So certainly getting vaccinated . . .

Scot: No, I'm not thinking about the flu shot that prevents the flu. I'm thinking if you think you have flu symptoms, I've been told go to the urgent care, go to a doctor because if it's within 48 hours, there's something they can give you that will help shorten the duration.

Justin: Yeah, it's an oral medication.

Scot: Oh, okay.

Justin: And Tamiflu, I'm sure you could ask 100 providers and get 100 different perspectives on it. The data is not super great, but it's kind of the only thing in our arsenal when it comes to treating things like the flu.

Troy: That's what's hard with it. As Justin mentioned, it's shown to help people who have a lot of other medical problems. For the average healthy person, based on what I've seen, it might decrease your duration of symptoms by 12 hours. Maybe it'll make you feel a little better. Hard to say. So instead of being sick for five days, you're sick for four and a half days. I don't know.

Scot: So for healthy people, maybe not necessarily going to shorten things too much. But if you're in one of the other populations that you're not super healthy, at-risk populations, it can actually help, like grandma, grandpa, immune-compromised individuals.

Justin: Absolutely.

Troy: People with lung disease, heart disease, things like that. But you kind of have to . . . like you said, Scot, you have to be there within 48 hours or it's completely useless. So within 48 hours of your symptoms, starting with that first fever, chills, coughing, whatever it is. And we can test you, but even then, the CDC recommendation basically says, "If it's flu season and someone has an influenza-like illness, they're coughing, they have fever, you can just treat them. Skip the test."

Scot: No need for a test. Do you use tests very often or can you generally tell?

Justin: We test quite a bit just because we have that available to us, and it's an easy quick test to do. But we also have . . . and this will be a little bit of a plug. This is a part of what we do in urgent care. We do virtual visits. And a lot of times, we'll have somebody that calls in on a virtual visit over an iPad or a computer, and they say, "Hey, you know, my husband, or my wife, or one of my kids was diagnosed with the flu. Can I get treatment over the phone kind of thing?" And we've been told from our administration and our facility, "Yeah, this is kind of what is recommended. We don't want people coming in getting other people sick in our clinic."

And so, yeah, it's kind of like a standalone recommendation, like Troy said, from the CDC. If it sounds like the flu, or you've had a high-risk exposure, sure, let's go ahead and treat it.

Scot: What about contagiousness? Like you just alluded to, you don't really necessarily want them coming into the clinic. You can do it over a televisit. A lot of workplaces now are really moving towards if you have the flu, just stay home. Is there a way to tell if I'm no longer contagious with the flu, or is it kind of ambiguous like a cold?

Justin: At least in our setting, fever plays a role in that. So if people are acutely febrile or have a high temperature, they're more likely to be contagious. After we get out of that fever state, less likely to be contagious, I think, generally speaking.

Troy: Yeah. And here's the problem too, because I've had people come in and they say, "Hey, I've got the flu. I'm worried about my family getting exposed to me now." And I say, "They've already been exposed. You were contagious for 48 hours before you started having symptoms."

Scot: Oh, okay.

Troy: So, yeah, you can tell them to take all the precautions, but decent chance they're getting sick.

Scot: They were exposed.

Troy: I mean, that's the tough thing.

Scot: Let's talk about the flu shot. So, I mean, there's a lot of I think myths and whatnot surrounding the flu shot. In your gentleman's opinion, it's effective?

Troy: It's effective. Like you said, it reduces your odds by about 50%.

Scot: Which is, you know . . .

Troy: It's good.

Justin: It's better than zero.

Scot: It's better than 0%, and it's usually pretty cost effective. A lot of times it's free, or $5, so whatever.

Troy: Yeah, it's free, and you figure time lost from work, you know, if you have to go to the hospital, all those expenses. So, yeah, if you're reducing your odds by 50% . . .

But I think the point there with what you said is also if you do get really sick, you may have the flu even if you had the flu shot, and you may benefit from something like Tamiflu, especially if you have other health issues.

Scot: All right. There you go. Thank you very much for telling us what we can do about colds and flus.

Now, I'm going to try something brand new here on "Who Cares About Men's Health." I have in my hand my little red megaphone. We're going to call this a megaphone moment. I'm going to hand you, Justin Knox, the little red megaphone. I want you to get up on the mountain and preach to the masses. What's your one sentence about what we talked about today?

Troy: I'm no help with this. I'm sorry. I haven't had to do the megaphone.

Justin: I'm quite confused.

Troy: He's putting you on the spot. I don't know.

Scot: You're quite confused, huh?

Justin: What am I doing on the mountain?

Scot: When it comes to colds or flu, if you could get one message out to the public or anything that they're facing in the wintertime, what would that be? What would you want them to know, or take away, or whatever?

Justin: Get your flu shot and wash your hands.

Scot: All right. There you go. The megaphone moment.

Troy: The voice speaks from the mountain. Get your flu shot, wash your hands. Good advice.

Scot: Justin, thank you very much for coming in, and thank you for caring about men's health.

Justin: Thank you.

Scot: All right. Just read a recent article here about the state of health. It's "The state of health report shows growing despair among American men." Got this off of yahoo.com. And up until this point, life expectancy for males had been getting longer and longer. I mean, we tend to think of that in industrialized societies, that all of our life expectancies would increase.

But men's life expectancies peaked in 2014. And since then, according to this study, they've continued to go down. And they say the decline is in part due to deaths of despair, which they define as drugs and suicide, which to me, when I talk about health, is not something I necessarily consider. I think about my exercise and that sort of thing. But according to this study, mortality rate from drug overdoses in men have nearly doubled. So that's a 100% increase.

Troy: Yeah, that's crazy.

Scot: Pretty crazy, in 10 years, from 2007 to 2017. In the same 10-year period, suicide rates have increased 24% in the population overall. They didn't have specific men numbers, but they do note that males in particular are more strongly impacted.

Troy: And the irony here, this is all happening while the economy is improving. You know, we're going back 10 years to the recession. Things are looking up, yet in general, as men, we're more likely to kill ourselves, to overdose on drugs and die of that. And as you said, we're having really a lower life expectancy than our parents' generation, and the first time really in I think many, many generations that our life expectancy is lower than our parents.

Scot: And this is kind of a new enemy. Up until this point, I've always just considered, again, my health is avoiding getting disease, eating well, exercising. You know, if I don't have a heart attack, I'm fine. But this really, again, redefines that there are some new things out there. I mean, they're not new, but we're starting to realize they could potentially impact our health.

With these increases coming along, I think it just kind of puts it up on the screen that this is something to be aware of. So now, as an individual, man, what do I do with that?

Troy: Yeah. It's really frustrating and kind of depressing to see this. I mean, as a physician trying to fight this battle and help these individuals, it's so challenging.

And I think maybe the takeaway from this to try and put a positive spin on this is, you know, for me often going into work can be therapeutic. And I don't want that to sound bad. I'm not looking at people like looking down on them. But sometimes when you're not feeling great about your life, and you go and you see a lot of people are really struggling out there, you realize, "I'm doing okay. I'm hanging in there. I'm doing okay. I'm doing what I want to do in terms of exercise and diet and that."

And so maybe seeing these statistics can be a positive thing to say, "Hey, it's a battle, and it's a struggle. But if you're trying to stay on top of things, yeah, you're going to have setbacks, but keeping up on your mental health, your physical health, your diet, your exercise, you're doing all right." Give yourself a pat on the back and keep going, because I think we all need that encouragement to recognize what a battle it is and to really stay in the battle.

Scot: I think my takeaway is that you really have to take it as a man seriously if you are starting to have depressive feelings, if you're starting to feel a lot of pressure, or . . . what are some of the classic symptoms of depression?

Troy: Poor sleep. We talk about sleep all the time. Poor diet. You lose interest in so many activities that were interesting to you before. It affects your interpersonal relationships, down to even thoughts about suicide, or planning things, or thoughts about death.

Scot: Getting angry very easy, it could be.

Troy: Easy to anger.

Scot: So I think this study really indicates that this is becoming more and more of a problem. So if you recognize those things in yourself, or in somebody else, or if you have a drug dependency that, you know, is becoming more and more likely that that's going to have negative impacts on your life, you just really need to take it seriously.

And realize that there's no stigma attached to it. I think, as men, we attach stigma to, "It's weak if I admit that I'm having a hard time." But it's not.

Troy: It's not. This is what is killing our generation. Get the help you need. Get the mental help you need, whether it's, again, depression, thoughts about suicide, drug abuse, whatever it is.

Scot: And how would you recommend somebody go about doing that as a physician?

Troy: Well, it's interesting. I remember when we talked to Jeremy Thueson, I loved how he said there are no wrong doors or no wrong entries to getting help. And I think that's the answer. However you want to get help. Go to the ER. If it's an emergency, go to the ER and get help. Go to your primary care physician. Get in touch with a therapist. Talk to a family member. They can help you get resources. Whatever it is, reach out to someone, and generally, they're going to get you on the right path.

Scot: And we know from evidence that these interventions do help.

Troy: They do.

Scot: They do make a difference. I think sometimes, when you're in that situation, you think, "Well, nothing is really going to help me," but we do know that they do help.

Troy: Absolutely. I've seen many, many cases of people who have reached out for help and been successful. Others where people haven't been, but again they've fought back, and they've gotten help later, and been successful. So keep working on it and keep trying.

Scot: All right. Time for "Just Going to Leave This Here." It might have something to do with health. It might not.

I'm going to start with my Just Going to Leave This Here. Interesting conversation about colds and flus. One of the things I did want to bring up but just didn't get an opportunity to is the role in the microbiome fighting off colds, flus, and other illnesses.

I noticed personally a huge difference when I started eating more vegetables. I eat a couple, maybe three, servings of vegetables in the morning. I make kind of a faux omelet. And then I usually have some vegetables in the afternoon. And ever since I've started eating better in that respect, I've noticed that my immune system seems to be able to ward off colds and flus and stuff, which I used to get a lot, a lot better.

So I wanted to look this up a little bit. And I didn't have a ton of time, but "The Seattle Times" had an article from a nutritionist that said about 80% of your body's immune cells live in your gut or your intestine.

And then it goes on to say, "The population of bacteria and other microbiomes that make up your gut microbiome play a big role in the strength of your immune system." And then they talk about the types of foods that will help strengthen your microbiome. And you're never going to guess what types of foods, Troy.

Troy: Fruits and vegetables.

Scot: You talk about it all the time.

Troy: Here we go.

Scot: More specifically.

Troy: That's the key.

Scot: So first of all, yogurt has that in it. Fermented foods has stuff that the microbiome likes. But a plant-based diet with lots of fruits and vegetables, along with beans, lentils, whole grains, nuts, and seeds will give your friendly microbes plenty to eat. And apparently . . .

Troy: Did you just cite the Mediterranean diet?

Scot: It sounds like I did.

Troy: It's like a recurring theme.

Scot: It is. So once again . . .

Troy: Yeah. It's amazing. It fights colds, helps your heart, all the above.

Scot: Yep. So it just comes back to our Core Four Plus One More, how important nutrition is. I have experienced this myself. There might be more robust research out there. But anyway, it's worked for me.

Troy: I love it. And exercise too.

Scot: Absolutely.

Troy: I mean, that makes a difference too, I think. I feel like exercising definitely has helped me to keep from getting as sick or as frequently sick as I used to get.

So I'm just going to leave this here. Scot, are you ready for winter?

Scot: No.

Troy: I'm not either.

Scot: My wife and I were talking about this just the other day. We're just not even ready for it.

Troy: I'm so not ready. I went running this morning, running at 6:30 in the morning. And I was running back home in a blizzard. It was just snow coming down and I . . .

Scot: It was snowing on you.

Troy: Yeah, it was snowing. I had a headlamp on. I couldn't see anything. It's like driving with your headlights on. It's just like a whiteout, and it just came out of nowhere. And I said, "I am not ready for this."

I don't know. I used to love winter because, you know, it's ski season. You're getting out in the snow, and that's fun. But I don't know. I've gotten to the point where I just don't know that I'm ready for winter. I'm trying to get excited for it. I think this last winter was just so long and so much snow, which was, again, great for skiing or snowshoeing, but I'm trying to get myself psyched for winter.

So I'm just going to leave this here. I'm not ready for winter.

Scot: Well, you've got no choice. It's coming whether you like it or not.

Troy: I know. What can you do?

Scot: All right. Time to say the things that people say at the end of podcasts. Let's try to split this up this time, Troy. You've kind of been Bogarting the whole thing.

Troy: I just got my list in my head, and once I get going on the list, I'm just like, "I've got to hit all these things."

Scot: Like a freight train, yeah. So be sure to rate and review our podcast. Give us an honest rating and review if you liked it. It helps other people find this podcast.

We're wherever podcasts can be found. Spotify is one of the most popular places people are listening to "Who Cares About Men's Health," but we're also on iTunes, and Stitcher, and the other places as well. To find out where you can, go to whocaresmenshealth.com.

Troy: Also, we'd love to hear from you. I don't know if anyone's actually contacted us yet with questions, but we would love to get questions. Don't hesitate at hello@thescoperadio.com.

You can check us out on Facebook, facebook.com/whocaresmenshealth. Our website is whocaresmenshealth.com. We'd love to hear from you. Get back with us. Feedback would be great. I'd love to get some health questions, topics, anything like that.

Scot: It's all very helpful, and it can ensure that we are talking about the things that matter and you care about.

Thank you very much for listening, and thank you for caring about men's health.